孕前体重指数、孕期体重增加与新生儿窒息发生率的关系

目的：探讨孕前体重指数、孕期体重增加量与新生儿窒息发生率的关系。方法：对2012年1月至2014年1月在我院参加孕前检查且分娩单胎活产儿的1522例孕产妇,其中新生儿窒息182例(11.96%),按孕前体重指数分为偏瘦组(BMI<18.5)、正常组(18.5≤BMI<24.0)、超重组(24.0≤BMI<28.0)、肥胖组(BMI≥28),按孕期体重增加分为<0.3 kg/周组、0.3~0.5kg/周组、>0.5 kg/周组,回顾性分析新生儿窒息发生率与孕妇孕前体重指数、孕期体重增加的关系。结果：偏瘦组(BMI<18.5)、正常组(18.5≤BMI<24.0)、超重组(24.0≤BMI<28.0)、肥胖组(BMI≥28)的新生儿窒息的发生率分别是10.60%、11.30%、16.10%、26.83%,呈逐渐递增的趋势;孕期增加体重<0.3 kg/周组、0.3~0.5 kg/周组、>0.5 kg/周组的新生儿窒息率分别为17.81%、11.41%、10.36%,随着孕期增重的增加,新生儿窒息率随之下降。结论：孕妇孕前体重指数(BMI)、孕期体重增加是新生儿窒息发生的重要影响因素,临床上应对孕妇孕前体重指数及孕期体重增加量进行监测,充分评估新生儿发生窒息的危险性,并及早行干预措施,降低新生儿窒息发生率,最大程度保障母婴安全。     

Prenatal maternal emotional complaints are associated with cortisol responses in toddler and preschool aged girls

Associations between prenatal maternal emotional complaints and child behavioral and cognitive problems have been reported, with different relations for boys and girls. Fetal programming hypotheses underline these associations and state that the early development of the HPA‐axis of the children may have been affected. In the present study, differences in cortisol responses of prenatally exposed and nonexposed children are examined for both sexes separately. Cortisol response patterns of a group preschool aged children that were prenatally exposed to high levels of maternal emotional complaints (N = 51) were compared to a nonexposed group (N = 52). Child saliva was collected at the start of a home visit (T1), 22 min after a mother–child interaction episode (T2), and 22 min after a potentially frustrating task (T3). Repeated measures analyses showed that prenatally exposed girls showed higher cortisol levels across the three episodes compared to nonexposed girls. No differences were found in boys. Maternal prenatal emotional complaints might be related to child HPA‐axis functioning differently for boys and girls. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 553–563, 2009.     

Maternal depression and cortisol in pregnancy predict offspring emotional reactivity in the preschool period

Prenatal exposures to higher levels of maternal cortisol and depression have been linked to a variety of adverse physiological, neurological, and behavioral outcomes, such as dysregulated cortisol production, structural and functional differences in limbic areas of the brain, and greater negative emotionality. This study investigated prospective associations between maternal prepartum depression/cortisol levels and offspring emotional reactivity in 163 mother–child pairs. Women were assessed repeatedly during pregnancy, and later participated in a laboratory visit with their preschool‐aged children. Mothers self‐reported on depressive symptomatology during pregnancy and provided saliva samples for cortisol assay. Offspring emotional reactivity was assessed through multiple measures, including caregiver reports, cortisol response following a stressor, and laboratory observations of behavior. The findings suggest potential prenatal timing effects, with depression and maternal cortisol measured in the first and second trimesters being more strongly associated with child emotional reactivity. Sex was found to moderate associations between maternal prepartum depression/cortisol and child emotional reactivity, with the general pattern reflecting positive associations in girls, and negative associations in boys.     

Maternal expressive suppression moderates the relations between maternal and child hair cortisol

Self-reports and physiological indicators of stress such as cortisol levels are correlated in maternal and child samples. This relationship is likely to be influenced by maternal emotion regulation. Herein, we investigate the moderating role of maternal regulation strategies on the association between maternal and child hair cortisol levels. Mother–child dyads (N = 63, child mean age = 49.74 months) participated in the study. Hair samples were collected from mother and child, and cortisol was assayed. Mothers reported on their own emotion regulation strategies, namely expressive suppression and cognitive reappraisal. As expected, mother and child hair cortisol levels were significantly correlated. Interestingly, the relation between maternal and child hair cortisol was moderated by maternal suppression of emotion. Mother and child hair cortisol levels were related at low levels of maternal suppression, but not at higher levels of suppression. Maternal cognitive reappraisal of emotion was not associated with cortisol levels.     

Pre-natal and perinatal factors affecting body mass index in pre-pubertal Polish children

Abstract

Background: An increased prevalence of body mass deficit among children has been reported in developing countries, including Eastern European states which have undergone political transformation. However, there are few studies evaluating risk factors for body mass deficit in schoolchildren and adolescents.

Aim: To assess selected familial, pre-natal and early life factors in terms of risk associated with the prevalence of body mass deficit in children aged 7–10 years.

Subjects and methods: Logistic regression models based on 812 records for children aged 7–10 years were applied for the evaluation of familial, pre-natal and perinatal risk factors affecting the height-to-weight ratio.

Results: The risk of underweight in 7–10-year-old children is significantly higher for girls (OR?=?1.70) and for children whose mothers reported a traumatic experience during pregnancy (OR?=?2.77). The effect of reported stress during pregnancy differed as regards the child’s sex. Mother’s trauma increased the risk of body weight deficit only in boys (OR?=?2.74), while in girls it significantly decreased this risk (OR?=?0.35). Low birth weight significantly increased the risk of underweight only in boys (OR?=?2.99) and mother’s occupational activity decreased the risk of underweight only in girls (OR?=?0.57).

Conclusion: Low birth weight and mother’s trauma during pregnancy are risk factors for underweight in Polish schoolchildren, particularly in boys.     

Maternal prenatal anxiety,postnatal caregiving and infants' cortisol responses to the still‐face procedure

This study prospectively examined the separate and combined influences of maternal prenatal anxiety disorder and postnatal caregiving sensitivity on infants' salivary cortisol responses to the still‐face procedure. Effects were assessed by measuring infant salivary cortisol upon arrival at the laboratory, and at 15‐, 25‐, and 40‐min following the still‐face procedure. Maternal symptoms of anxiety during the last 6 months of pregnancy were assessed using clinical diagnostic interview. Data analyses using linear mixed models were based on 88 women and their 7‐month‐old infants. Prenatal anxiety and maternal sensitivity emerged as independent, additive moderators of infant cortisol reactivity, F (3, 180) = 3.29, p = .02, F (3, 179) = 2.68, p = .05 respectively. Results were independent of maternal prenatal depression symptoms, and postnatal symptoms of anxiety and depression. Infants' stress‐induced cortisol secretion patterns appear to relate not only to exposure to maternal prenatal anxiety, but also to maternal caregiving sensitivity, irrespective of prenatal psychological state. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 625–637, 2009     

孕前体重指数对多囊卵巢综合征患者妊娠结局的影响

目的比较不同体重指数对多囊卵巢综合征（polycystic ovarian syndrome,PCOS）患者妊娠结局和新生儿结局的影响。方法回顾性分析2011年1月至2013年12月于首都医科大学附属北京妇产医院产科就诊的PCOS孕妇328例,按照孕前体重指数（body mass index,BMI）分为体重正常组（BMI 18．5～24．9kg／m^2）和超重及肥胖组（BMI≥25．0kg／m^2）,比较两组PCOS孕妇妊娠结局及新生儿结局等情况。结果超重及肥胖组的既往流产率和辅助生殖技术助孕妊娠比例、妊娠期糖尿病、妊娠期高血压疾病和胎盘早剥的发生率显著高于正常体重组（P〈0．05）;两组问胎膜旱破、胎儿生长受限、前置胎盘和产后出血等并发症无统计学差异（P〉0．05）;在分娩方式上,超重及肥胖PCOS孕妇与对照组相比顺产率低而剖宫产率高,早产和巨大儿的发生率也显著增加,差异具有统计学意义（P〈0．05）。结论孕前超重及肥胖的PCOS患者发生妊娠期并发症的风险增高,新生儿容易出现不良结局,对这类患者应加强健康管理,孕前即注意体重的控制以改善母婴结局。     

The role of membrane stage in the interaction of cortisol with hepatocytes

We studied the effect of polyvinylpyrrolidone-immobilized cortisol on the distribution of glucocorticoid-receptor complexes in hepatocytes. Immobilized cortisol 1.2-1.5-fold increased the number of glucocorticoid-receptor complexes associated with the nuclei in a dose-dependent manner. The transport of glucocorticoid-receptor complexes into hepatocyte nuclei induced by immobilized cortisol is associated with their activation. Moreover, the ratio between nuclear pools of glucocorticoid-receptor complexes resistant to 0.2 and 0.4 M KCl extraction was changed. It was concluded that glucocorticoid binding to specific plasma membrane sites induced further stages of interaction between the hormone and competent cell.     

Maternal behavior and maternal stress are associated with infant behavioral development in macaques

The simultaneous effects of naturally occurring individual differences in maternal care and maternal peripartum stress on infant development have been sparsely reported in nonhuman primates. In this work, we used a comparative approach to assess how changes in peripartum maternal excreted cortisol levels and the quality of mother-infant interactions correlate with infant behavioral development in group-living rhesus and Japanese macaques. We tested the hypothesis that peripartum maternal stress was associated with infant behavioral characteristics during development. Due to the difference in mothering style between the two species, we provided separated analyses for two groups. A sample of mother-infant pairs (Japanese macaques, N = 14; rhesus macaques, N = 10) was observed during the first 3 months of the infant's life. Follow-up observations (at 5, 7, and 9 months of age) were collected for the infants. Maternal cortisol levels were measured during the peripartum period. We found preliminary evidence that maternal peripartum stress and differences in key components of maternal behavior are associated with infant behavior throughout the developmental phase. We also provided a working hypothesis regarding maternal behavior and maternal stress as factors playing unique roles in different components of infant behavioral development.     

Association between the interaction of SMAD3 polymorphisms with body mass index and osteoarthritis susceptibility

Purpose: This study aimed to investigate the relationship between the interaction of SMAD3 polymorphisms (rs12102171 and rs2289263) with body mass index (BMI) and osteoarthritis (OA) susceptibility. Methods: This study involved 112 OA patients and 120 healthy people. The controls were frequency-matched with the cases by age and sex. Hardy-Weinberg equilibrium (HWE) was tested by χ² test in the control group. The rs12102171 and rs2289263 polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The relative risk of OA was represented by odds ratio (OR) with 95% confidence interval (CI) calculated by chi-squared test. Gene-environment interaction was analyzed by crossover analysis. Results: The TT genotype and T allele of SMAD3 rs12102171 polymorphism were more frequent in case than control groups (P=0.04 in both of two polymorphisms), which increased the risk of OA (OR=3.39, 95% CI=1.03-11.11 and OR=1.64, 95% CI=1.03-2.59). GG genotype and G allele were also the risk factors for OA (OR=3.22, 95% CI=1.09-9.51 and OR=1.57, 95% CI=1.02-2.42). The BMI had interactions with genotype CC and CT+TT of rs12102171 and TT and TG+GG of rs2289263 (rs12102171: OR=2.15, P=0.02 and OR=3.99, P=1.00×10^-3; rs2289263: OR=2.73, P=4.00×10^-3 and OR=4.67, P=0). Conclusions: CC and CT+TT and TT and TG+GG genotypes of SMAD3 rs12102171 and rs2289263 polymorphisms together with BMI may be susceptible factors to OA, and interactions there between can possibly confer risk to OA.     

Preoperative body mass index and physical function are associated with length of stay and facility discharge after total knee arthroplasty

Background

Hospital length of stay (LOS) and facility discharge are primary drivers of the cost of total knee arthroplasty (TKA). We sought to identify modifiable patient factors that were associated with increased LOS and facility discharge after TKA.

Conceptualizations,measurement, and effects of prenatal maternal stress on birth outcomes

This article analyzes the conceptual and methodological approaches which have been used to investigate effects of prenatal maternal stress on birth outcomes and highlights the major findings of this research. By viewing the most widely used operational definitions of prenatal stress in a broader theoretical framework, it can be seen that most studies have failed to conceptualize stress reliably. This, in addition to common methodological and design flaws which are described in the article, has produced equivocal findings about the role of stress in adverse birth outcomes such as preterm delivery and low birth weight. Recent studies using more powerful, multidimensional approaches to stress definition and measurement provide more definitive evidence and suggest some precise effects. Implications and strategies for future research are presented.This work was supported in part by National Institutes of Health Biomedical Research Support Grant funds (S07RR07067-25). The author would like to thank Christine Dunkel-Schetter, Howard Friedman, Camille Wortman, and Paul Wortman for their comments on drafts of this article.     

Total testosterone and sex hormone-binding globulin are associated with metabolic syndrome independent of age and body mass index in Korean men

ObjectiveThe purpose of this study is to investigate the relationship between sex hormones and metabolic syndrome independent of age and BMI in Korean men.Study designWe conducted a cross-sectional study with data from a health promotion center during the period from March 2007 to February 2010. 2172 Korean men aged 21–79 were enrolled. Total testosterone, sex hormone-binding globulin (SHBG), high density lipoprotein (HDL) cholesterol, triglyceride (TG), and glucose were assessed with overnight fasting serum samples.Main outcome measuresSex hormones were divided into quartiles; odds ratios for metabolic syndrome and each component were analyzed.ResultsTotal testosterone showed negative associations with waist circumference (WC), fasting glucose, TG, blood pressure and body mass index (BMI), and a positive relationship with HDL cholesterol (P for trend <0.001, respectively). SHBG was negatively associated with WC, fasting glucose, TG, and BMI, and positively associated with total testosterone and age. Comparing with the highest quartile, odds ratios of lowest quartile of total testosterone and SHBG for metabolic syndrome were 3.01 (95% CI, 2.11–4.28) and 6.34 (95% CI, 2.29–17.58), respectively, after adjusting for age, smoking status, alcohol intake, exercise, and BMI. Total testosterone was significantly associated with each metabolic component and SHBG was associated with glucose and TG after adjustment for age, smoking status, alcohol intake, and BMI. Calculated free testosterone had no significant relationship with metabolic syndrome or its components.ConclusionTotal testosterone and SHBG are negatively associated with prevalence of metabolic syndrome independent of age and BMI in Korean men.     

孕前体重指数、孕期增重与糖耐量异常及新生儿出生体重的关系

目的探讨孕妇孕前体重指数及孕期体重增加情况对糖耐量异常及新生儿出生体重的影响。方法测量385例足月单胎初产妇孕前身高、体重和孕期体重增加情况,计算孕前体重指教,并随访糖耐量异常、巨大儿和低体重儿的发生情况。结果（1）孕前肥胖的孕妇糖耐量异常的发生率高于孕前消瘦和理想体重的孕妇（P〈0．05）,而后两组间无差别（P〉0．05）。发生巨大儿和低体重儿的几率3组比较差异无显著性。（2）无论孕前体重指数如何,当孕期体重增加≥18kg时糖耐量异常和巨大儿的发生率明显增高（P〈0．01）,而当孕期体重增加〈9kg时低体重儿的发生率明显增高（P〈0．01）。结论孕前体重指数和孕期增重是孕期发生糖耐量异常的重要影响因素,新生儿出生体重与孕妇孕期体重增加情况密切相关。     

Gestational sleep deprivation is associated with higher offspring body mass index and blood pressure

Study ObjectivesThe objective of this study was to evaluate the association between gestational sleep deprivation and childhood adiposity and cardiometabolic profile.MethodsData were used from two population-based birth cohorts (Rhea study and Amsterdam Born Children and their Development study). A total of 3,608 pregnant women and their children were followed up until the age of 11 years. Gestational sleep deprivation was defined as 6 or fewer hours of sleep per day, reported by questionnaire. The primary outcomes included repeated measures of body mass index (BMI), waist circumference, body fat, serum lipids, systolic and diastolic blood pressure (DBP) levels in childhood. We performed a pooled analysis with adjusted linear mixed effect and Cox proportional hazards models. We tested for mediation by birthweight, gestational age, and gestational diabetes.ResultsGestational sleep deprivation was associated with higher BMI (beta; 95% CI: 0.7; 0.4, 1.0 kg/m²) and waist circumference (beta; 95% CI: 0.9; 0.1, 1.6 cm) in childhood, and increased risk for overweight or obesity (HR; 95% CI: 1.4; 1.1, 2.0). Gestational sleep deprivation was also associated with higher offspring DBP (beta; 95% CI: 1.6; 0.5, 2.7 mmHg). The observed associations were modified by sex (all p-values for interaction < 0.05); and were more pronounced in girls. Gestational diabetes and shorter gestational age partly mediated the seen associations.ConclusionsThis is the first study showing that gestational sleep deprivation may increase offspring’s adiposity and blood pressure, while exploring possible mechanisms. Attention to glucose metabolism and preterm birth might be extra warranted in mothers with gestational sleep deprivation.     

The effect of parity on maternal body mass index,plasma mineral element status and new-born anthropometrics

BackgroundAdverse pregnancy outcome is an important public health problem that has been partly associated with increasing maternal parity.AimTo determine the effect of parity on maternal body mass index (BMI), mineral element status and newborn anthropometrics.MethodsData for 349 pregnant women previously studied for the impacts of maternal plasma mineral element status on pregnancy and its outcomes was analysed. Obstetric and demographic data and 5mls of blood samples were obtained from each subject. Blood lead, plasma copper, iron and zinc were determined using atomic absorption spectrophotometer.ResultsMaternal BMI increases with parity. Women with parity two had significantly higher plasma zinc but lower plasma copper with comparable levels of the elements in nulliparous and higher parity groups. Although plasma iron was comparable among the groups, blood lead was significantly higher in parity > three. Newborn birth length increases with parity with a positive correlation between parity and maternal BMI (r = 0.221; p = 0.001) and newborn birth length (r = 0.170; p = 0.002) while plasma copper was negatively correlated with newborn''s head circumference (r = −0.115; p = 0.040)ConclusionIt is plausible that parity affects maternal BMI and newborn anthropometrics through alterations in maternal plasma mineral element levels. While further studies are desired to confirm the present findings, there is need for pregnant and would-be pregnant women to diversify their diet to optimize their mineral element status.     

Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence

Recent biosocial theories postulate that both biological risk and the social context influence the development of mental health problems [Boyce and Ellis (2005) Development and Psychopathology, 17(2), 271-301]. Guided by this framework, we examined whether basal cortisol and its diurnal rhythm were associated with mental health symptoms in early adolescence. Because cross-sectional and longitudinal investigations sometimes reveal different cortisol-mental health associations, we examined the association both concurrently and longitudinally when children transition to middle school, a time which entails a major change in social context from single to multiple teachers, classrooms, and sets of classmates. Salivary cortisol was measured three times a day (waking, afternoon, and bedtime) across 3 days when adolescents were 5th graders. Mental health was measured when adolescents were in 5th and 7th grades, just before and after the transition to middle school. To deal with the substantial comorbidity of internalizing and externalizing symptoms at this developmental stage, mental health measures distinguished overall symptom severity from the preponderance of internalizing versus externalizing symptoms (i.e., directionality). A three-level Hierarchical Linear Model was used to extract basal cortisol and its diurnal rhythm separate from the day-to-day and within-the-day fluctuations in cortisol in response to daily experiences. Results were specific to symptom severity, suggesting that cortisol is a nonspecific risk factor for mental health symptoms in young adolescents. At 5th grade, low basal cortisol was associated with concurrent symptom severity. However, longitudinally, it was adolescents with high cortisol at 5th grade who were at risk for increasing mental health symptoms by 7th grade. Flat diurnal rhythms in 5th grade were related to levels of symptom severity at both 5th and 7th grades. Considering the change in social context, as defined by the transition to middle school, helped resolve seemingly inconsistent evidence that both hypo- and hyper-arousal were associated with mental health symptoms in early adolescence.